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Mobilizing for enrollment: Veterans and the health care law

How does the upcoming rollout of Obamacare affect Georgia’s 770,000 military veterans?

Are their VA benefits changing? What should veterans do if they’re uninsured now?

The Department of Veterans Affairs earlier this month sent out a letter to veterans explaining their options under the Affordable Care Act. Nationally, 8.7 million veterans are enrolled in the VA health program.

First, the 2010 law won’t change VA benefits. And if a vet is enrolled in VA health care, that coverage meets the standards for the health reform law’s insurance requirement. So that veteran will not face any penalties for not having health insurance in 2014.

That’s one reason the Department of Veterans Affairs expects to see its veteran patient population grow by about 66,000, a senior VA official told Congress in April.

According to the Urban Institute, there are an estimated 1.3 million uninsured veterans under age 65 in the United States, constituting roughly 10 percent of the nonelderly veteran population nationally. The estimate in Georgia is about 56,000 veterans without health insurance.

In the recent letter, the VA urges all qualified people who have no coverage to enroll in its health care system. There are no enrollment fees, monthly premiums or deductibles, and most veterans have no co-pays. (Some vets who have sufficient means pay modest co-pays.) Because enrollment takes time due to the need to verify eligibility, it’s best to sign up quickly.

Not everyone who has served in uniform qualifies for VA health care. “It’s a common misconception that everyone gets VA coverage,’’ says Amanda Ptashkin of the consumer advocacy group Georgians for a Healthy Future.

One major group who do not meet the basic eligibility requirement for VA care are Reserve or National Guard vets who served on active duty for training purposes only.

(In recent years, it has become common for Reserve and Guard members to be called up for active duty and sent on assignment just like members of the regular military. If they are on active duty long enough, these troops can earn standard VA benefits. But from the 1950s through the ’80s, Guard and Reserve members were rarely called up, and many served for years without earning enough active-duty time to qualify for benefits. )

Overall, a veteran’s eligibility is determined by length of active service, type of discharge, service-connected disabilities, and income level, among other factors. Contrary to one common myth, war service is not required; there are many peacetime veterans in the VA health system.

But not all veterans who are eligible for VA care are enrolled. Genevieve Kenney of the Urban Institute’s Health Policy Center, who has co-authored studies on uninsured veterans, says that one possible explanation is that some uninsured vets who could qualify may not be aware that VA coverage is available to them.

Kenney adds that ACA-related changes — such as the availability of trained navigators, the screening of applications for a variety of programs, along with the fact that VA coverage will satisfy the individual mandate, could raise veterans’ enrollment in VA services.

More than 300,000 children of veterans and more than 600,000 spouses of veterans are uninsured, and most are not eligible for VA care, Kenney notes.

She says that more than 40 percent of uninsured veterans and over 50 percent of uninsured family members report having unmet health care needs.

Veterans who aren’t eligible for VA – and their families — could go to the health insurance exchange, or marketplace. But another option, gaining Medicaid coverage, is limited in states that aren’t expanding the program. Georgia has rejected Medicaid expansion.

Ironically, in states that don’t expand Medicaid, the poorest adults don’t qualify for the subsidies in the health insurance exchange.

About 20,000 low-income uninsured veterans would be eligible for Medicaid if Georgia expanded the program, but at the same time won’t receive subsidies in the health insurance exchange either.

“It doesn’t seem like it’s a big enough issue for people who object to the ACA,’’ says Tim Sweeney, director of health policy for the Georgia Budget and Policy Institute.

In Georgia, there are three VA hospitals and more than 20 clinics throughout the state.

Here are some ways to enroll in VA care or determine your eligibility: